2-1-1 Texas is experiencing intermittent technical difficulties. We are aware of the problem and are working to restore service as quickly as possible.
Find a COVID-19 testing site | COVID-19 vaccine | More COVID-19 information
Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
If still having trouble viewing or downloading a form, click here.
Documents
-
Document
-
Document
Instructions
Updated: 11/2019
Purpose
Form 3048 is completed to notify applicants if they are eligible for the Title V Fee-for-Service Program, Primary Health Care Services Program or Epilepsy Program benefits.
Form 3048 is also completed to notify clients of the Title V Fee-for-Service Program, Primary Health Care Services Program or Epilepsy Program benefits to report changes in their situation and their liability if they fail to report changes.
When to Prepare
Complete the form for individuals applying for the Title V Fee-for Service Program, Primary Health Care Services Program or Epilepsy Program benefits.
Number of Copies
Complete an original and one copy.
Transmittal
Give the original form face-to-face or mail the form to the individual applying for assistance. File a copy in the case record.
Form Retention
Keep the case record copy for three state fiscal years after eligibility begins. However, eligibility is valid for a maximum of 12 months.
Detailed Instructions
Complete the information listed on the form.